In Northern Uganda, Male Mentors Spread the Word on Family Planning

A hundred men in Acholi region have been trained to advocate for family planning, by spreading awareness and counselling other men on the health and financial benefits of respecting their wives’ rights to help make decisions on when and how many children they have.

GULU, UGANDA – When Josephine Lamwaka was growing up, she watched her father abuse her mother almost every day, sometimes even threatening to kill her with a machete. Lamwaka’s father also forbade her mother from using contraception or visiting the local family planning clinic.

With her parents as her only model for marriage, Lamwaka, 30, didn’t expect much respect or support from her husband, Patrick Okello, when they got married five years ago. But he surprised her.

When Lamwaka told him about her need to use contraception, Okello, 46, who already had five children from a previous marriage, agreed. He accompanied her to a health facility near their home in Koro sub-county, in northern Uganda’s Acholi region, to get an intrauterine device (IUD) fitted.

While most women in her neighborhood start having babies as soon as they get married and conceive almost every year, Lamwaka waited three years before having her firstborn. She says she and Okello have decided they want to have only two more children, spaced out by several years.

“My mother says, ‘You are a blessed woman. We have never seen a man like this,’” Lamwaka says with a smile.

Okello has not always treated women so well. He says he used to be an alcoholic and confesses he physically abused his first wife. But after learning that respecting his wife’s rights and decisions has a positive effect on everything from mental health to income, he became a family planning advocate. Now he is one of 100 Role Model Men in northern Uganda who spend their free time teaching other men about the benefits of family planning.

“I wasn’t a good husband before. I learned that one way to start living well … was to treat my wife fairly,” Okello says. “By accepting family planning, men can take care of their family’s finances and health in a better way.”

Okello was first introduced to the concept of women’s rights in 2010 as part of a CARE project called Roco Kwo: Transforming lives in Acholi region. From 2014 to 2017, he became involved in a pilot project initiated by CARE and run on the ground by Gulu Women Economics’ Development and Globalization that aimed to engage men in challenging negative social norms and practices that limit women’s access to health services.

Across nine of the region’s sub-counties, 100 men were trained on the basics of reproductive and maternal health. After that, each man was responsible for mentoring, counseling and conducting dialogues with men of 10 other households in his village. The project encouraged men to involve their wives in family planning decisions, to accompany them to health clinics, and to get tested for HIV/AIDS and other diseases.

‘You Have to Target Men’

Until 2006, the residents of northern Uganda had lived through 20 years of active conflict between the government and the Lord’s Resistance Army (LRA) rebel group. The fighting internally displaced approximately 1.8 million people. An estimated 66,000 children and young adults were abducted during that period, to be used by the rebels as porters, sex slaves and soldiers.

“In northern Uganda, because of the conflict and also our culture, a project of this kind is crucial,” says Geoffrey Oyat, a program officer with Gulu Women Economics’ Development and Globalization.

During and after the conflict, women’s access to reproductive and sexual health services was severely limited due to safety concerns, geographical constraints, and the collapse and later slow recovery of Uganda’s health system.

While the situation has since improved, the Acholi region still has a high proportion of women who cannot access the services they need. According to the 2016 Demographic and Health Survey, 39 percent of currently married women in the region have an unmet need for family planning, compared to the national average of 28 percent.

The conflict and its aftermath increased existing gender inequalities in Uganda’s patriarchal society. Men make the decisions on family planning, but those decisions are poorly informed and based on ingrained cultural norms.

“Since we are in a post-conflict environment, men say they lost many of their children in the insurgency and need to reproduce more to fill the gap. Many women face gender-based violence at home if they opt for a family planning method,” says Dannis Kibula, the regional technical officer with the NGO Family Health International (FHI) 360.

“If you want a family planning project to succeed in this region, you have to target men.”

One reason to make sure men are involved, Kibula says, is that the high fertility rate in northern Uganda does not just lead to higher health risks such as maternal mortality, but also increases the socioeconomic burden on already impoverished communities. Many rural families continue to believe more children means a bigger labor force and that will lead to more income.

“In families where the husbands are heavy drinkers, if the woman is not wise enough to opt for family planning, she will just be giving birth every year because the man does not control himself,” Okello says. “It is not easy to transform these households and men, but it is possible.”

To create more awareness, health workers worked together with Role Model Men to conduct community sensitization and outreach sessions on sexual and reproductive health in the sub-counties. At the end of the project’s second year, many health facilities recorded an increase in hospital deliveries, antenatal check-ups, child immunization and use of family planning methods.

Although the pilot phase ended last year, Okello and other Role Model Men say they are proud of the impact their work has had and they continue to engage with households in their free time.

Shifting the Burden

The Role Model Men project fits within the government’s 2015–2020 development plan to increase men’s involvement in family planning programs and shift some of the burden from women. But an evaluation published in 2016 showed that while the interventions had reached more than 80 percent of the target group, still only a fifth were using modern contraceptive methods and only two percent of men had had a vasectomy.

“Most men are unwilling to use condoms or opt for vasectomies. It has been our biggest challenge,” Oyat says.

Filda Ajok, 39, is grateful there are men in her community in Lamogi subcounty willing to take on that challenge. She and her husband Patrick Odok were struggling to support their eight children, following the decade they had spent in an internal displacement camp, when Odok met a Role Model Man. Soon after, Odok gave up alcohol and decided that their ninth child would be their last one. Together they agreed that Ajok would use a contraceptive implant.

Odok still won’t use a condom and isn’t convinced about the need to have a vasectomy. “What if I decide to marry another wife in the future?” he says. But now he helps Ajok with the household chores and working the family’s field.

“Earlier my husband’s behavior was such that I thought he was possessed,” says Ajok, who hopes the same support will be available to her children – eight of whom are girls – when they get older.

“Things are okay now,” she says. “I can focus on the future of my eight daughters.”